Psych iatric Aspects of HTLV-1 infection - PowerPoint Presentation

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Psychiatric Aspects of HTLV-1 infection

By: Dr Farhad Faridhosseini

Psychiatrist

Mashhad Medical University

HTLV-1

Topics

Prevalence of HTLV-1

seropositivity

in psychiatric patients.

Psychiatric complications in HTLV-1 carriers or patients.

Psychiatric assessment of these patients.

Pharmacologic & Psychotherapeutic interventions

Viral Hypothesis for Schizophrenia

Indirect evidence suggest that viral infection during CNS development may be involved in the pathogenesis of schizophrenia:

an excess number of patient births in the late winter and early spring

an association between exposure to viral epidemics in

utero

and the later development of schizophrenia.

a higher prevalence of schizophrenia in crowded urban areas

seroepidemiological

studies indicting a higher infection rate for certain viruses in schizophrenia patients or their

mothers:

Borna

virus, Influenza, Rubella

Is HTLV-1 infection could be etiology for psychiatric disorders?

Psychiatric patients showed

a

seroprevalence

rate similar to that for the

controls

(

Cubo

et al, 1997, Kagoshima, Japan).

Lack of evidence for retrovirus

infection in

schizophrenic

patients

(

Delisi

et al, 1985)

.

HTLV-1 infection appeared to have no correlation

with psychiatric disorders.

HTLV-1 & dementia

frequency

of anti-HTLV-I antibody was found to be significantly higher in the patients with dementia

than

in those without

dementia.

Among

the various types of dementia, HTLV-I

seropositivity

was found to be significantly associated with vascular

dementia.

The presence of HTLV-I

appears

to be one of the risk factors for vascular dementia in HTLV-I endemic

areas (

Kira

et al, 1997, Japan)

IV drug abusers

HTLV-1

infections appear to be widely distributed among high-risk groups in a

nonendemic

area of

Argentina.

co-infection

with HBV and HCV more frequent among

IV Drug Users.

(

Berini

et al. 2007)

HTLV-I is present in Greece among populations at high-risk

.

(

Tseliou

et al. 2006)

Frequency of psychiatric symptoms in HTLV-1 patients

42%

HTLV-1

patients had

a psychiatric co-morbidity;

34% had

mood disorders,

22% were anxious.

a

higher frequency

of mental disorder in the symptomatic

subgroup, patients on medication & female.

The rate is similar

to those observed in studies carried out

into patients

with chronic diseases (31% to 66%)

and

to

those reported

for HIV patients (45

%).

(

Carvalho

et al, 2009, Brazil)

Depression in HTLV-1 carriers

The rate of depression was

significantly higher

in HTLV-l carriers when compared with controls (39% vs. 8

%).

It was

not possible

to determine whether depression was related to knowledge of

chronic retroviral

infection or related to a biological effect

of the

retroviral infection

.

(

Stumpf

et al., 2009, Brazil)

donors

seropositive

for HTL V-1/2 had worse scores on a depression

subscale of General Well-Being Scale.

(

Guiltinan

et

al, 1998)

Relationship between Depression and HTLV-1 infection

chronic viral infection

may

produce a widespread

dysregulation

of the immune system that may lead

to depressive symptoms.

IL-1 & IL-6 have

been associated with depressive symptoms through direct

brain activity.

decreased immune

function associated

with depression could be related to increased susceptibility

to immune-mediated diseases.

stigma and the stress of

having serious

complications like HAM-TSP or ATL may turn patients with

HTLV-I infection

vulnerable to develop

depression.

depressed patients

may be

more likely to engage in behaviors that put them at risk for contracting HTL

V and

other viruses

Sexual dysfunction

high frequency of urinary and sexual complaints not only in patients with

myelopathy

but also in individuals considered to be HTLV-I

carriers.

(

Oliviera

et al, 2007, Brazil)

The percentage of

Erectile Dysfunction

in the

carriers was

40.5

%

a

nd in HAM/TSP

group, ED frequency was 88.2

%.

(Castro et al, 2005, Brazil)

It may be the first symptom of HAM/TSP.

Cognitive deficits

Both the HTLV-1 carrier group and the group of patients with TSP/HAM exhibited a lower performance in neuropsychological

tests

(Silva et al, 2003):

Psychomotor slowing, verbal

and visual memory, attention and

visuomotor

abilities.

Progressive Cognitive decline in childhood HAM/TSP

(case report by

Zorzi

et al, 2010).

Subcortical

dementia could be seen

(Cartier et al., 1999)

Chronic pain

Chronic pain was highly

prevalent.

(

Netto

&

Brites

, 2011)

It

was significantly associated with a

higher likelihood

of signs/symptoms of anxiety and depression,

reflecting a

negative impact of pain on patients´ quality of life.

Psychiatric assessment

History taking

R/O Depression

Anxiety

Cognitive impairment

Erectile dysfunction

Level of functional impairment

Stigma and patient’s perspective

Health behavior & high risk groups

Drug interaction

Effects of Drugs on psychiatric symptoms.

Treatment of psychiatric complications

SSRIs are safer except

Fluvoxamine

Buspirone

could be effective

Benzodiazepines could be used but with precaution

Clozapine

is contraindicated because of its

drug interactions

stimulants for cognitive impairment & depression

Treatment of substance dependency

Psychotherapy:

Stigma: education & give information

Uncertainty and anxiety: relaxation, cognitive appraisal

Pain:

mindfullness

deal with many losses

Thank You